Provider Demographics
NPI:1760448120
Name:BROWN, VALERIE (PA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 20-150
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:312-695-8146
Mailing Address - Fax:312-695-7030
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 20-150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-8146
Practice Address - Fax:312-695-7030
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002587363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK23086Medicare ID - Type Unspecified
ILQ57885Medicare UPIN